Munroe Falls Fire Department
Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU (AS A PERSON RECEIVING EMERGENCY MEDICAL SERVICES FROM THE MUNROE FALLS FIRE DEPARTMENT) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.


Please review this notice carefully:

The Munroe Falls Fire Department is required by the Privacy Regulations Created as a Result of the Health Information Portability and Accounting Act of 1996 (HIPPA), to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.


Disclosure of Your Health Care Information
Treatment            

Health care information pertaining to your medical condition and treatment to you by members of the Munroe Falls Fire Department and other medical personnel (including doctors and nurses who give orders allowing us to provide treatment to you).  It also includes information to other healthcare personnel whom we transfer your care and treatment, and includes transfer of health care information via radio or telephone to the hospital or through dispatch and telecommunication centers, as well as providing the hospital with a copy of the written report we create in the course of providing you with treatment and transport.  It will also include providing health care information to other emergency service personnel in the event mutual aid is requested to assist in your care or transport within our practice for the purpose of treatment, payment or healthcare operations.

Payment               

In order to bill and collect payment for the services and items you may receive.  For example, the Munroe Falls Fire Department may provide your insurer with details regarding your treatment to determine if your insurer will cover or pay for your treatment.  The Munroe Falls Fire Department may use and disclose your health care information to obtain payment from third parties that may be responsible for such costs, such as family members.  Also, the Munroe Falls Fire Department may disclose your health care information to other health care providers for their payment purposes.  Certain disclosures may be to individuals or entities the Munroe Falls Fire Department contracts with in order to perform various functions on the department's behalf, such as billing, after assurance has been made to appropriately safeguard your information.

Health Care Operations                    

The Munroe Falls Fire Department may use and disclose your health care information to operate or improve emergency medical services.  As examples of the way in which your information may be used and disclosed for operations, the department may use your information to evaluate the quality of care you received from us, in administering disease management programs, or to conduct cost-management and response-time planning activities for medical emergencies.


Release of Information to Family/Friends                     

The Munroe Falls Fire Department may release information to a family member, other relative, close personal friend or other personal representative that you identify.  Such a use shall be based on how involved the person is in your care or for purposes of payment.  The Munroe Falls Fire Department may release information to parents or guardians, if allowed by law.  If you are not present or able to agree to these disclosures of your health care information, then, using our professional judgment, the Munroe Falls Fire Department may determine whether the disclosure is in your best interest.  Even if you designate a personal representative, the law permits the Munroe Falls Fire Department to elect not to treat the person as such if there is reason to believe that: (1) you have been, or may have been, subject to domestic violence, abuse or neglect by such person; (2) treating such a person as a personal representative could endanger you; or (3) in the exercise of the department's professional judgement, that it is not in your best interest to treat the person as your personal representative.

 

Disclosure Required By Law           

The Munroe Falls Fire Department will use and disclose your health care information when required to do so by federal, state, or local law.  One example of a required disclosure is for the purpose of determining compliance with the privacy law.


Workers' Compensation                  

The Munroe Falls Fire Department may disclose your health information as necessary to comply with State Workers' Compensation Laws.


Emergencies       

The Munroe Falls Fire Department may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.


Public Health      

As required by law, the Munroe Falls Fire Department may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.


Judicial and Administrative Proceedings         

As required by law, the Munroe Falls Fire Department may disclose your health information in the course of any administrative or judicial proceeding.


Law Enforcement

The Munroe Falls Fire Department may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.


Deceased Persons              

The Munroe Falls Fire Department may disclose your health information to coroners or medical examiners to identify a deceased individual or to identify the cause of death.  If necessary, information may be released in order for funeral directors or organ donor organizations involved in procuring, banking, or transplanting organs and tissues.


Research              

The Munroe Falls Fire Department may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.


Public Safety       

It may be necessary to disclose your health information to appropriate persons in order to prevent of lesson a serious and imminent threat to health or safety of a particular person or to the general public.


Specialized Government Agencies 

The Munroe Falls Fire Department may disclose your health information for military, national security, prisoner and government benefits purposes.


Your Health Information Rights
    • You have the right to request restrictions on certain uses and disclosures of your health information.  Please be advised, however, that the Munroe Falls Fire Department is not required to agree to the restriction that you request.

    • You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.

    • You have a right to inspect and copy your health information.

    • You have the right to request that the Munroe Falls Fire Department amend your protected health information.  Please be advised, however, that the Munroe Falls Fire Department is not required to agree to amend your protected health information.  If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.

    • You have the right to receive an accounting of disclosures of your protected health information made by the Munroe Falls Fire Department.

    • You have the right to a paper copy of this Notice of Privacy Practices at any time upon request.


Changes to this Notice of Privacy Practices
The Munroe Falls Fire Department reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains.  A copy of the current notice of privacy practices shall be posted at the Munroe Falls Fire Department, Station #1, 43 Munroe Falls Avenue, Munroe Falls, Ohio, 44262 in a visible location at all times, one the Munroe Falls Fire Department web site www.munroefalls.com and you may request a copy of the most current notice at any time.  Until such amendment is made, the Munroe falls Fire Department is required by law to comply with this Notice.


Questions about this Notice of Privacy Practices
The Munroe Falls Fire Department is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information.  If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: Chief James S. Bowery by calling the office at (330) 688-7493 during office hours between 9:00 a.m. through 5:00 p.m.  If Chief James S. Bowery is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.


Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Munroe Falls Fire Department or with the Secretary of the Department of Health and Human Services.  All complaints must be submitted in writing.

This notice is effective as of April 14, 2003

 

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